Medicare home health patients' transitions through acute and post-acute care settings.
OBJECTIVE
To describe Medicare beneficiaries' transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use.


METHODS
The 2004 Chronic Condition Data Warehouse, including the Medicare 5% standard analytic file and OASIS. Study participants were 66,510 Medicare beneficiaries with a home health start of care assessment between January 15, 2004 and July 15, 2004 who were discharged before December 1, 2004.


RESULTS
Home health patients frequently incurred acute and post-acute services during the 14 days preceding admission and the 30 days after discharge, predominantly in acute hospitals. Substantial differences were observed in beneficiaries' health and functioning across living arrangements; patients living alone were less medically complex, less disabled, and received less assistance than those living with others. Agreement between OASIS and administrative claims was uniformly low with regard to inpatient hospital, inpatient rehabilitation, and skilled nursing facility use in the 14 days preceding the home health start of care. Agreement between OASIS and administrative claims was uneven for the period after discharge from home health care; it was determined to be near perfect for inpatient hospital (kappa = 0.85), but was lower for inpatient rehabilitation and hospice (kappa = 0.22 and 0.10, respectively).


CONCLUSIONS
Findings reinforce the potential merit of patient-specific rather than setting-specific measures of quality, but underscore practical challenges to constructing measures that span data sources and episodes of care.
Wolff
Jennifer L
JL
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. jwolff@jhsph.edu
Meadow
Ann
A
Weiss
Carlos O
CO
Boyd
Cynthia M
CM
Leff
Bruce
B
D000367:Age Factors; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States